I've got a sore knee OSCE by Michael

 
You have 3 minutes reading time. This OSCE will run for a maximum of 7 minutes.

Scenario:

A 56yo man has presented with a 2-day history of a swollen, red and painful right knee. He has a history of gout and is an IV drug user. He takes no regular medications, and has no allergies. He has recently returned from a trip to Thailand.

You are asked by a resident to perform a knee arthrocentesis.

Instructions for the candidate

You are to gain informed consent from the patient, and then perform a knee arthrocentesis. The resident will assist you, but does not want to do the procedure. The results will be immediately available for interpretation.

Domains being examined

  • Medical Expertise
  • Communication
  • Scholarship and Teaching
  • Professionalism
 
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 7 minutes.

For the actor

Patient: You are a reasonably well man with an alternative lifestyle. Your knee has been exquisitely painful for 2 days, and you have felt a little off with no specific other symptoms.

Resident: You are a junior doctor and have not seen a knee arthrocentesis performed before.

For the examiner

Provide fluid analysis results after arthrocentesis complete.

Appearance:

WCC: 30,000/mL
Polys: 95%
Microscopy: No crystals

Domains Assessment Objectives

Medical Expertise
Procedural proficiency in knee arthrocentesis.
Knowledge of joint fluid analysis.

Communication
Establish rapport, clearly articulate whilst gaining informed consent and during procedure.

Scholarship and Teaching
Good explanations and information for junior doctor.

Professionalism
Professional approach throughout.

Other Assessment Notes

1. Consent
- Description of procedure and indication
- Contraindications: cellulitis, bleeding diathesis
- Complications: infection, bleeding, allergy, pain

2. Procedure
- Position, equipment
- Landmarks (anteromedial, mid to upper patella, enter needle horizontally)
- Aseptic technique
- Sample collection (bonus points for string sign)
- Post procedure care

3. Results
- Adequate interpretation
- Good treatment plan - commence antibiotics, orthopaedic referral for washout, fasting, IVT, analgesia, assess haemodynamics


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